From the Guidelines
Management of an insect bite typically involves simple home remedies and over-the-counter treatments, with the primary goal of reducing symptoms and preventing infection, as recommended by the most recent guidelines 1. The first step in managing an insect bite is to clean the bite area with soap and water to prevent infection.
- Apply a cold compress or ice pack wrapped in cloth for 10-15 minutes to reduce swelling and pain.
- For itching and inflammation, use an over-the-counter antihistamine like diphenhydramine (Benadryl) 25-50mg every 4-6 hours or cetirizine (Zyrtec) 10mg once daily, as supported by clinical trials 1.
- Topical treatments such as 1% hydrocortisone cream applied 2-3 times daily for 3-5 days or calamine lotion can also help relieve itching.
- For pain, acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil) 400-600mg every 6-8 hours can be effective. It is essential to avoid scratching the bite to prevent secondary infection.
- These treatments work by reducing the body's inflammatory response to insect saliva or venom.
- Seek medical attention if you develop severe symptoms like extensive swelling, spreading redness, fever, difficulty breathing, or if the bite appears infected, as emphasized in the guidelines 1. People with known severe allergic reactions to insect bites should use their prescribed epinephrine auto-injector immediately and seek emergency care, as highlighted in the practice parameter update 1.
From the FDA Drug Label
Emergency treatment of allergic reactions (Type I), including anaphylaxis, which may result from allergic reactions to insect stings, biting insects, foods, drugs, sera, diagnostic testing substances and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis. Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... insect bites For the management of an insect bite, epinephrine (IM) 2 may be used in cases of anaphylaxis. For minor skin irritations and itching associated with insect bites, hydrocortisone (TOP) 3 may be used.
- Key considerations include:
- Severity of the reaction: anaphylaxis requires immediate treatment with epinephrine
- Symptoms: itching, inflammation, and rashes may be managed with hydrocortisone
From the Research
Management of Insect Bites
- Insect bites can cause local reactions, immune reactions, and secondary bacterial infections, with simple bites being those that do not involve anaphylactic shock or systemic infection 4.
- The management of simple insect bites often involves the use of over-the-counter preparations such as antihistamines and topical corticosteroids, although there is a lack of evidence for their efficacy 4.
- For more severe reactions, such as anaphylaxis, emergency treatment may involve the use of epinephrine and corticosteroids, with the latter reducing the length of hospital stay but not necessarily reducing revisits to the emergency department 5.
Emergency Treatment and Prevention
- Emergency treatment of insect-sting anaphylaxis often involves the use of epinephrine, with corticosteroids also being used to reduce the severity of reactions 6, 5.
- The development of a simple clinical definition of anaphylaxis is needed to facilitate identification of cases and improve emergency management 6.
- Patients with large local reactions to insect stings may benefit from consultation with an allergist to determine the best course of treatment and whether venom immunotherapy is necessary 7.
Treatment and Prevention of Specific Insect Bites
- Mosquito bites can be prevented through the use of insect repellents and good first aid techniques, with counseling on these methods able to reduce the risks posed by summertime pests 8.
- The management of insect bites may involve the use of different treatments depending on the type of insect and the severity of the reaction, with a lack of evidence for the efficacy of many over-the-counter preparations 4, 8.